Physiotherapy Role in Geriatric Oncology

Original Editor - Tolulope Adeniji
Top Contributors - Tolulope Adeniji, Kim Jackson, Vidya Acharya, Chelsea Mclene and Areeba RajaThis article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (Template:18/Template:07/Template:2020)

Overview of Geriatric Oncology

Geriatric oncology is a special area that deals with issues surrounding assessmeny and management of older adults with cancer.Due to ageing process that is complex, most newly diagnosed cancers are among this population. And it is essential to understand the baseline health status of a patient before making treatment decisions. Generally, a geriatric assessment is supposed to be a comprehensive evaluation that includes medical, psychosocial, and functional problems in older patients with cancer. Geriatric oncology should includes specific areas such as identification of vulnerability, predicting survival and toxicity, assist in clinical treatment decisions, and guide interventions in routine oncology practice. The information on this write up will elaborates on how physiotherapy contributes to geriatric oncology practice.

Epidemiology

Ageing is an indirect risk factor for cancer and one reason for this can be linked to increase exposure to carcinogenic substances in greater time that could predispose such individual to genetic changes and eventually tumor Cancer is highly prevalent among the older adults and the incidence and mortality of cancer increases with age. However, at very old age, >90 years, cancer prevalence decreases. Aside the ageing being risk factors of cancer, gender is also associated with some certain cancer. Among common cancer in older adults, incidence of the following cancer are high among male gender: prostate, lung, and bowel cancers, while, breast, lung, bowel, stomach, and uterine cancer are of higher incident in female gender

Aetiology

The underlying causes of cancer among older adults can be explain based on the biology of ancer and impact of ageing. These can be explain under the following heading:

• Molecular Changes
• Cellular Changes
• Tumorogenesis: A Simplified Model
• Physiologic Changes

For more information on the above biology of cancer and ageing kindly see follow this link [aging.html|https://www.hopkinsmedicine.org/gec/series/cancer_aging.html#biology]

Assessment and Investigations

Geriatric assessment and investigations is an essential process to evaluate if an older adult is fit, vulnerable, or frail. The assessment encompass age-related conditions that should be investigate within the period of cancer treatment. One important of this is that it will guide care to best management line.

The US National Comprehensive Cancer Network (NCCN) and International Society of Geriatric Oncology (SIOG) recommendation for geriatric oncology assessment are to be shoulder on the following  features: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes

Oncology Examination

Clinical Manifestations

Clinical manifestations of an older adults with cancer is a multi-factorial symptoms. It is an overlap between the following clinial manifestations:

• Geriatric comordiities (Congestive heart failure, diabetes, hypertension, anemia, depression, COPD etc)
• Age related deficits in body systems such as increase prevalence of urinary incontinence in urinary system, Presbycusis in sensory system, sarcopenia in musculoskeletal system etc.
• Geriatric syndrome (combination of one or more of the following: falls, frailty, polyharmacy, delirium, dementia etc

Physiotherapy Management

Common Problems:

• Impaired bed mobility

• Difficulty with transfers

• Decreased muscle strength

• Decreased ambulation

• Decreased ROM, cardiovascular endurance

• Impaired balance

• Pain

Physical activity guidelines recommendation for Healthy Older Adults

American College of Sports Medicine and the American Heart Association.moderate recommendation for healthy older adults:

• Aerobic

Moderate aerobic for 5-6/10) 5 days/wk, 30 mins/day, bouts of 10 mins each

(vigorous, 7-8/10) 3 days/wk, continuous for at least 20 mins/day

• Strengthening

At least 2 days/wk, 8-10 exercises (major mm groups),

10-15 reps

• Flexibility/Balance

At least 2 days/wk; for those at risk for falls- include

balance

Exercise Guidelines for Cancer Survivors

General Statement

• Avoid inactivity. Return to normal ADLs as quickly as possible after surgery.
• Individuals with known metastatic bone disease will require modifications to avoid fractures.
• Individuals with cardiac conditions may require modifications and supervision for safety.

Aerobic •Breast/Prostate/Colon/Hematologic/Gynecologic- Same as age-appropriate PAG for Americans

•Adult HSCT- OK to exercise everyday; lighter intensity, and lower progression of intensity; avoid

overtraining/vigorous ex

•Colon- MD permission to engage in contact sports

Resistance •Breast- supervised program with very low resistance; watch out for UE symptoms/lymphedema;

fracture risk

•Prostate- add pelvic floor exercise for radical prostatectomy; fracture risk

•Colon- start with low resistance and progress resistance slowly for patients with stoma to avoid

herniation

•Adult HSCT- resistance training might be more important than aerobic ex

•Gynecologic- proceed with caution if patient has lymph node removal or RT

Flexibility •Breast/Prostate/Hematologic/Adult HSCT/Gynecologic- Same as age-appropriate PAG for

Americans

•Colon- avoid excessive abdominal pressure for patients with ostomy

Prevention

Brief consideration of how this pathology could be prevented and the physiotherapy role in health promotion in relation to prevention of disease or disease progression.

Resources

add appropriate resources here